At this juncture, you may want to take a look at that flow chart that I began our discussion with.
Do not lose sight of what we're trying to accomplish.
Our objective for that flow chart was to take a normal cell and then upon exposure to various elements
such as chemicals that I walked you through, including arsenic, such as chromium,
such as nitrosamines, so on and so forth, the patient may develop a cancer
or if the patient is being exposed to certain viruses here, may develop cancer.
Let's talk about HPV now.
Our topic is a DNA virus that the patient has been exposed to and he or she develops cancer.
HPV is a big deal. Listen, with HPV you should be thinking about sexually transmitted infection, right, STI.
With HPV, it could be male or female, put them both together
and with HPV you should be thinking about the higher strains,
not the lower. My topic is cancer, 16, 18, 31, and 33. And with HPV,
in a female you begin with the following:
There might be vulvar issues so they might be squamous or cancer of the vulva.
You keep going. There might be issues within the vagina and in the cervix.
Would you tell me the part of the cervix that's facing you,
meaning facing you as a clinician when you do a pelvic exam? That's the exocervix.
What kind of cells is your exocervix? Squamous. There you are in the transformation zone. Are you there?
Put yourself in the cervix, the transformation zone
that which is facing the external world, exocervix is squamous.
That which is facing the uterus endocervix is the columnar.
That's your transformation zone.
Keep all that in mind because with HPV, 85% of the time, if the patient, cervical cancer,
where is your patient most likely coming from? Developed or developing countries?
Good. Developing countries, 85% of the time.
If you're in the transformation zone, the virus has a choice of either becoming
an adenocarcinoma or a squamous cell cancer -- 85% of the time, what is it going to choose?
Squamous, squamous, squamous. Clear?
Not only that, with the HPV, maybe you have a couple that practices oral sex and fellatio, so on and so forth.
So there's every possibility that HPV might enter the head and the neck,
may result in head and neck cancer, guess what kind? Squamous.
Now unbelievably you've learned an immunology
that you even have a vaccination for this and it's called GARDASIL.
You're guarding against squamous intraepithelial lesion. Where? Vulva, cervix, head neck.
Isn't that amazing, that you actually have a vaccine that may prevent certain cancers from taking place.
And then molecularly, if you remember from micro, with HPV, these strains contain E6 and E7.
What do they do? Knock out the tumor suppressor gene p53 and what's the other one.
RB, E6, E7 respectively. HPV, you should know everything about HPV.
What about the lower strain? Condyloma acuminata. What? Remember warts?
That's your condyloma acuminata. You know everything about HPV. Low strain, high strain.
Low strain, high strain. Our topic, high strain.
Alright, let's move on to EBV.
EBV is all over the places, oh, my goodness. Usually infects B cells and if it's B cells
then what kind of CD are you looking for?
Good. 19, 20, 21, you should be focusing on 21.
These are epithelial cell of the nasopharynx, nasopharynx, CD21.
So if that's the case, is it possible that EBV might give rise to nasopharyngeal cancer?
Sure. Who's your population? Far east, Japan and company.
Our topic with EBV associated highly with Burkitt lymphoma, translocation 8;14 -- 8;14.
By the time we're done with our discussion of cancer,
we'll have gone through three major translocations that contain 14, 14, 14 -- 8;14, 14;18, 11;14.
Once again, 8;14, Burkitt; 14;18, follicular; 11;14. I'm sorry, what? Good. Mantle cell.
Burkitt lymphoma specifically what if I give you an African-American boy,
the boards will you give you an African-America boy.
Actually, not even African-American, literally from Africa, a child.
Where is Burkitt lymphoma affecting that African child?
Mandible, that's the one that EBV is associated with moreso, whereas -- we call that the endemic type.
The non-endemic type and we'll come to that, well, that'll be the North American type, sporadic.
Not so much with EBV. B-cell lymphomas, immunocompromised, Hodgkin's big time.
The most common Hodgkin is not mixed cellularity, the most common Hodgkin's
would be the sclerosing type also associated with EBV, mixed cellularity as well.
What do you have to find pathologically on biopsy the diagnosed Hodgkin,
without this, you cannot call it Hodgkin. Reed-Sternberg cell. What is it?
It's a B-cell, it's a lymphoma. And there's the pharyngeal.
We began by talking about EBV and CD 21, population here, Far East.
Our topic is DNA viruses, so far HPV, EBV and hepatitis B. Why there's no hepatitis C here?
Because hepatitis C is a RNA virus.
So next, when we talk about RNA, we'll talk about hepatitis C. Hepatitis B
could be associated by chronicity, could be associated with hepatocellular carcinoma of the liver.
RNA viruses that are important for you of developing cancer.
Whenever you think about hepatitis C you should be thinking about C, hepatitis C, C,
chronicity, hence associated with hepatocellular carcinoma.
They have an interesting one here, it's called HTLV-1, human T-cell lymphotropic virus one.
You focus upon the letter T, HTLV virus 1, may give rise to T-cell leukemia/lymphoma
the gene here that you'll have to know is tax, T, T, T,
HTLV-1, adult T-cell leukemia/lymphoma, tax.
Know these three first step, you'll be in good shape.
These are important RNA viruses, there are a bunch more,
but at least know these two, associated with cancer.
Bacteria associated with cancer. Obviously this brings us to H. pylori.
Helicobacter pylori loves to live either in the antrum of the stomach
or it loves to live in the first part of the duodenum, so right around here, right, in that area.
The antrum and the first part of the duodenum, H. pylori, you talk about urease,
you know that it produces a force field, these thing's like a super hero,
but it's actually a super villain, isn't it? It creates a force field and of composed of alkaline, H. pylori.
And at some point, with H. pylori, it might give rise to a gastric adenocarcinoma
and that's called intestinal type, and helicobacter pylori might then give rise to a second gastric cancer here,
and it's called, Maltoma. Mucous associated lymphoid tissue. Welcome to B-cell type.
Well, I'm emphasizing B, because in the gut, in the GI system, if it's any type of lymphoma
that the patient's going to develop, it is going to be a B-cell, a extranodal, non-Hodgkin's lymphoma,
and we call this a diffuse large B-cell lymphoma.
Can reverse with treatment, that's unbelievable, isn't it?
The fact that you can actually treat a cancer by giving H. Pylori. Excuse me.
You can treat a cancer by treating H. pylori. Antibiotic kills off the cancer, of course, the boards loves this.
And you're thinking about drugs, such an H2 blocker, maybe clarithromycin;
antibiotic bismuth there as well
and it's important that we pay attention to the management when the time is right. We also have a PPI as well.